title: Methotrexate therapy followed by suction curettage followed by Foley tamponade for caesarean scar pregnancy.
abstract: OBJECTIVE
  Caesarean scar pregnancy (CSP) is a very rare and dangerous form of pregnancy because of the increased risk of rupture and excessive hemorrhage. There is currently no consensus on the treatment. We studied if methotrexate (MTX) therapy followed by suction curettage followed by Foley tamponade was a viable treatment for patients with CSP.
  
  
  METHODS
  Forty-five patients with CSP in our hospital received a single dose of 50mg/m(2) MTX by intramuscular injection. If gestational cardiac activity was seen on transvaginal ultrasound, local injection of MTX was given. After 7 days, suction curettage was performed to remove the retained products of conception and blood clot (CSP mass) under transabdominal sonography (TAS) guidance. After the suction curettage, a Foley catheter balloon was placed into the isthmic portion of cervix.
  
  
  RESULTS
  Forty-two subjects were successfully treated and 3 subjects failed treatment. The mean estimated blood loss of all 45 patients was 706.89 ± 642.08 (100-3000)ml. The resolution time of the serum β-hCG was 20.62 ± 5.41 (9-33) days. The time to CSP mass disappearance was 12.57 ± 4.37 (8-25) days.
  
  
  CONCLUSIONS
  MTX administration followed by suction curettage followed by Foley tamponade was an effective treatment for caesarean scar pregnancy.
authors.affiliation: Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, Liaoning Province 110004, China. jiangt@sj-hospital.org
authors.forename: Tao
authors.initials: T
authors.lastname: Jiang
authors.forename: Guipeng
authors.initials: G
authors.lastname: Liu
authors.forename: Ling
authors.initials: L
authors.lastname: Huang
authors.forename: Haining
authors.initials: H
authors.lastname: Ma
authors.forename: Shulan
authors.initials: S
authors.lastname: Zhang
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D058738:Uterine Balloon Tamponade; D014619:Vacuum Curettage; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate